Should we continue to offer extrapleural pneumonectomy to selected mesothelioma patients? A single center experience comparing surgical and non-surgical management

Our plain-English summary of Should we continue to offer extrapleural pneumonectomy to selected mesothelioma patients? A single center experience comparing surgical and non-surgical management, by M. Baud, A. Bobbio, F. Lococo, et al (Japanese Journal of Clinical Oncology, 2014).

The study

• Authors: M. Baud, A. Bobbio, F. Lococo, J.F. Regnard, M. Alifano
• Journal: Japanese Journal of Clinical Oncology
• Published: 2014;44(11):1127-9
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma remains an incurable disease for which the optimal therapeutic approach remains an extremely debated issue. Though not yet clearly defined, a subset of patients may benefit from a surgery-based multimodal treatment plan, beyond what would be expected with non-surgical therapies only. Indeed, despite some disappointing results on the feasibility of a multimodality treatment (chemotherapy ± surgery and post-operative radiation therapy) based on a lung sacrificing surgery (extrapleural pleuropnemonectomy) have been recently reported, the question concerning the role of extrapleural pneumonectomy in selected mesothelioma patients is still unanswered. In the light of this, we have reviewed our mono-institutional retrospective experience in the mesothelioma management, discussing on the role of extrapleural pneumonectomy in the multimodality treatment.

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In plain English

This short communication from a thoracic surgery department in Paris looked back at patients with malignant pleural mesothelioma treated between 2000 and 2010. The authors compared 32 patients who had induction platinum-based chemotherapy followed by extrapleural pneumonectomy with patients from their previously published series of 170 consecutive cases. Those patients had only diagnostic surgery and platinum-based chemotherapy. Patients chosen for surgery were younger (mean 58.9 versus 72.7 years). They had lower anesthesia risk scores, lower C-reactive protein levels and lower white blood cell and platelet counts, and more often had epithelioid tumors. Identified asbestos exposure was recorded in 59% of the surgery group and 46% of the others, a difference that was not statistically significant. No patient died during the operation, and 2 of 32 (6.2%) died within 30 days. Median survival was 20 months with surgery and 13 months without. Survival at 2, 5 and 7 years was 42.5, 27 and 27% with surgery versus 26, 11 and 5% without. The authors concluded that results were satisfactory in carefully selected patients and called for randomized trials.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Short communication reporting a single-center retrospective comparison of patients who had extrapleural pneumonectomy versus patients from a previously published series who had medical treatment only
• Who was studied: Patients with malignant pleural mesothelioma at the authors' institution in Paris, 2000 to 2010: 32 who underwent extrapleural pneumonectomy, compared with a previously published series of 170 consecutive cases who did not have surgery beyond diagnosis
• Exposure: The comparison was between treatments: induction platinum-based chemotherapy (gemcitabine before 2005, pemetrexed after 2005) followed by extrapleural pneumonectomy, versus surgical diagnosis and platinum-based chemotherapy only. Asbestos exposure was recorded as a patient characteristic: identified in 19 (59%) of the surgery group and 73 (46%) of the non-surgery group, P 0.16. No fiber types were reported.
• Main results:
  • No intraoperative deaths occurred in the surgery group. 30-day mortality after surgery was 6.2% (2 of 32).
  • Median survival was 20 months in the surgery (EPP) group and 13 months in the non-surgery group.
  • Survival at 2, 5 and 7 years was 42.5, 27 and 27% in the EPP group versus 26, 11 and 5% in the no-EPP group (log-rank P = 0.019).
  • Patients selected for surgery were significantly younger (mean 58.9 versus 72.7 years). They had lower ASA scores (P = 0.012) and lower C-reactive protein, white blood cell and platelet counts. They more often had epithelioid histology (97% versus 81%).
  • Disease-free survival and recurrence rates were also better in the EPP group (no figures given).
• The authors' conclusion: The authors concluded that results in the surgery group were satisfactory in long-term survival with acceptable 30-day mortality. They also concluded that careful selection of surgical candidates probably represents the key to offering this aggressive treatment, and that specifically designed randomized trials are needed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Mesothelioma, Pleural Mesothelioma, Chemotherapy.

Related studies

• Which is the Role of Pneumonectomy in the Era of Parenchymal-Sparing Procedures? Early/Long-Term Survival and Functional Results of a Single-Center Experience — A. Janet-Vendroux, M. Loi, et al. (2015)
• Summary of prognostic factors and patient selection for extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma — C. Cao, T.D. Yan, et al. (2011)
• Impact of induction therapy on postoperative outcome after extrapleural pneumonectomy for malignant pleural mesothelioma: does induction-accelerated hemithoracic radiation increase the surgical risk? — P. Mordant, K. McRae, et al. (2016)
• Pleurectomy/decortication is superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma — L. Lang-Lazdunski, A. Bille, et al. (2012)
• Extrapleural pneumonectomy in the treatment of epithelioid malignant pleural mesothelioma: novel prognostic implications of combined N1 and N2 nodal involvement based on experience in 529 patients — D.J. Sugarbaker, W.G. Richards, et al. (2014)
• Clinical experience of volumetric modulated arc therapy for malignant pleural mesothelioma after extrapleural pneumonectomy — T. Kimura, Y. Doi, et al. (2015)

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